The systematic analysis presents modern data on the effect of the analgesic component of various types of anesthesia on labor. During the analysis of publications localized in foreign and domestic scientific databases (PubMed, Cochrane, elibrary), 46 articles were selected after the initial identification of scientific publications, applying inclusion and exclusion criteria. The conducted systematic analysis allows us to formulate the conclusion that among a number of anesthesia methods used in natural childbirth, epidural anesthesia is the most applicable, and levobupivacaine is the drug of choice, which has the most differentiated motor block, lower cardio and neurotoxicity compared to other local anesthetics. A number of authors have demonstrated the advantages of non-neuroaxial methods. A significant part of the studies conducted have shown the effectiveness of intravenous opioids, but their use is associated with a number of side effects on the mother’s body.

Obesity and bronchial asthma are diseases that often accompany each other. Studies show that obesity increases the risk of developing bronchial asthma and makes it worse. In such cases, it is important to apply a comprehensive approach to treatment, including diet therapy. Personalized diet therapy can help patients not only reduce body fat, but also improve lung function and relieve asthma symptoms. In this article we will consider the basic principles of dietary therapy for such patients, as well as the relationship between diet, obesity and bronchial asthma. 
Material and methods. Analysis of literature over the past 15 years using databases dataPubMed, eLIBRARYby key words: “obesity”, “bronchial asthma”, “systemic inflammation”, “diet”. 
Results. Obesity has been shown to be accompanied by chronic inflammation, which can aggravate the inflammatory process in the airways in bronchial asthma. Studies show that diet therapy has a direct effect on inflammatory processes in the body. The diet, which contains a large amount of simple carbohydrates and saturated fats, plays an important role in causing systemic inflammation in obesity and worsening symptoms of bronchial asthma. On the other hand, studies show that a diet rich in antioxidants and polyunsaturated fatty acids can reduce inflammation in the body and improve control of asthma in obese patients. 
Conclusion. A number of studies have been carried out on dietary therapy for patients with obesity and asthma, but their results are contradictory and require further consideration.

The composition of the intestinal microbiota is associated with the course of diseases such as chronic kidney disease, arterial hypertension and coronary heart disease. Patients with CKD, hypertension and coronary artery disease often experience changes in the composition of the microbiota, which may be associated with an increase in inflammatory processes, metabolic disorders and other factors that contribute to the progression of these diseases. The gut microbiota can change in response to treatment, improving the patient’s condition. This review highlights a uremic toxin produced by the gut microbiota, phenylacetylglutamine (PAG), which may be an excellent indicator of the likelihood of in-stent restenosis or hyperplasia. An increase in the number of bacteria of the genus Lachnospira can lead to postoperative complications after coronary artery bypass grafting.

Justification. The occurrence of cardiovascular diseases (CVD) is influenced by many modifiable and unmodifiable risk factors, the number of which is constantly growing. One of these factors can be a violation of the composition of the oral microbiome. Its structure is quite variable. The predominance of certain microorganisms can not only cause local pathology, such as the development of caries or periodontitis, but also lead to systemic changes. The most pathogenic bacteria living in the oral cavity are Porphyromonas gingivalis, Streptococcus mutans, and bacteria of the genus Eikenella, the colonization of which is a risk factor for infectious endocarditis (IE), as well as coronary heart disease (CHD). Prevention of CVD should be aimed not only at the already known risk factors for cardiovascular pathology (obesity, emotional stress, metabolic syndrome, smoking, etc.), but also at the oral microbiome. 
Goal. To prove the existence of a relationship between the pathology of the oral cavity and the development of CVD. 
Material and methods. The analysis of publications was carried out using the following databases: PubMed, RSCI, Science Direct, CyberLeninka, Web of Science. The literature review includes 94 sources over the past 10 years. 
Conclusion. The composition of the oral microbiome plays a significant role in the pathogenesis of CVD. Bacteria synthesize substances that mediate immune and inflammatory reactions, and can also migrate into the bloodstream, contributing to the development of atherosclerosis, CHD and IE, contributing to the development and progression of hypertension and chronic heart failure. It is necessary to pay attention to the prevention of oral dysbiosis as a risk factor for the development and progression of somatic pathology.

Iron deficiency (ID) is a common comorbidity in patients with chronic heart failure (CHF). The presence of ID worsens the course of CHF, decreases the tolerance to physical activity, and reduces patients’ quality of life. The efficacy of intravenous iron supplementation has been demonstrated in patients with reduce ejection fractions. However, its effects on patients with preserved ejection fractions (HFpEF) and ID are not well-known. 
Aim. To assess the dynamics of functional status and quality of life among patients with HFpEF and ID receiving ferric carboxymaltose (FCM) therapy. 
Material and methods. Fortyfive patients with HFpEF and ID were included. The median age of the patients was 67 years [65, 73]; 68.9% were women (n = 31). Iron correction using FCM was performed in 18 patients (Group 1); patients without FCM formed a control group (Group 2, n = 27). Baseline and 6-month indicators included the 6-minute walk test (6MWT) and quality of life assessed by Minnesota Heart Failure Living with Heart Failure Questionnaire (MHFLQ). 
Results. The groups were comparable in terms of sex (p = 0.901) and age (p = 0.161). Initial parameters of iron metabolism did not differ significantly between the groups. Initial 6MWT values were 318 m [284.5; 367.3] in Group 1 and 350 m [305; 403] in Group 2 (p = 0.313). MHFLQ scores did not differ, with Group 1 scoring 33.5 points [22.8; 39.8] and Group 2 scoring 36 points [25; 42] (p = 0.728). After 6 months, 6MWT in Group 1 increased to 344 m [316.5; 363.5] (p = 0.011). Quality of life scores for MHFLQ in Group 1 declined to 28 points [9.8; 35] (p = 0.009). 
Conclusion. Treatment with FCM in patients with HFpEF and ID was associated with improvements in functional status and quality of life parameters at 6-month follow-up.

Objective. To evaluate the adherence to the recommended therapy of coronary heart disease in patients with stable and unstable forms of angina pectoris in a cardiology hospital.
Material and methods. The study included 221 patients with a verified diagnosis of coronary heart disease, according to clinical recommendations, in accordance with the principles of the Helsinki Declaration. The assessment of adherence to drug therapy was carried out using R.V. Kadyrov’s original questionnaire, which was supplemented with questions on the assessment of overall adherence to specific medications recommended for patients with coronary heart disease. All respondents underwent coronary angiography, if indicated and with their consent. 
Results. According to the data obtained, the progressive course of angina pectoris is mainly affected by men of working age. The adherence scale showed that the proportion of non-committed and partially committed patients was higher in the group with unstable angina and hemodynamically significant coronary artery atherosclerosis. 
Conclusion. It is necessary to search for new and effective ways to increase the level of adherence to the recommended treatment of coronary heart disease.

To evaluate the prognostic value of cardiac chamber remodeling in patients with ST-segment elevation myocardial infarction and SARS-CoV-2 infection (COVID-19). 
Materials and methods. A prospective cohort study included 60 participants, matched for age, gender, and the Charlson Comorbidity Index. The participants were divided into three groups of 20: the study group, which included patients with STEMI and COVID-19; a comparison group of patients with STEMI but without COVID-19; and a third comparison group consisting of patients with COVID-19 but without STEMI. The analysis of instrumental data and long-term follow-up of patients after hospital discharge were conducted. 
Results. In patients with STEMI and COVID-19, various types of LV myocardial remodeling were most often observed. The patients with COVID-19 without STEMI showed the highest LV ejection fraction (LVEF): 60.0 (55.5–60.0%), whereas STEMI with COVID-19 groups had LVEF as 54.5 (47.5– 58.0), and STEMI without COVID-19 had LVEF: 49.5 (46.0–55.5), p = 0.005. The median of LVMi g/m2 in STEMI and COVID-19 group was 117.8 (106.1–132.5); in COVID-19 group without STEMI — 110.1 (89.4–130.9); lower LVMi were detected in the group with STEMI without COVID-19 - 92.4 (85.5–111.3), p = 0.027. Signs of pulmonary hypertension (PH) were significantly more frequently found in patients with COVID-19: 7 patients of STEMI + COVID-19 group, and in 9 subjects of the non-STEMI group, whereas in patients with STEMI without COVID-19 in only 1 patient, p = 0.014. MACE were the most common outcome in the group with STEMI and COVID-19: there were 5 deaths and 4 hospitalizations due to non-fatal MI. In the COVID-19 group without STEMI, there were 4 deaths and 1 hospitalization due to non-fatal MI. In the STEMI group without COVID-19, no adverse cardiovascular events were observed during the follow-up period after inpatient treatment. An assessment of the odds ratio in patients with STEMI with COVID-19 and patients with COVID-19 without STEMI in the long-term follow-up period showed a significant association between the effect of the enlarged left atrium (LA) presence (OR 24.556; CI 2.752-219.100; p < 0.001), dilation of both atria (OR 13.750; CI 2.847–66.401; p = 0.001) and signs of pulmonary hypertension (PH) (OR 4.886; CI 1.211–19.715; p = 0.041) forecast the development of adverse cardiovascular events in the long-term follow-up period. 
Conclusions. Patients with STEMI and COVID-19 are at greater risk of MACE in the long term compared to patients with STEMI without COVID-19. LV myocardial remodeling, increased LVMi and decreased LVEF are common in patients with STEMI and COVID-19. The presence of LP dilation, dilation of both atria, and signs of PH in patients with COVID-19 is a risk factor for the development of adverse cardiovascular events.

According to numerous studies, the number of people in older age groups is increasing every year, which makes it necessary to study age-related diseases. These include sarcopenia, while its general pathogenetic relationship between type 2 diabetes mellitus is traced. The detection of sarcopenia in patients with type 2 diabetes mellitus contributes to an increase in the duration and quality of their life.
The aim of the study was to study the prevalence of presarcopenia in patients with type 2 diabetes mellitus, as well as to identify risk factors contributing to the prediction of sarcopenia in patients with type 2 diabetes. 
Material and methods. A single-stage, single-center, cross-sectional study of patients over 60 years of age who were hospitalized in the endocrinology department of Buyanova State Clinical Hospital due to decompensation of carbohydrate metabolism was conducted. During hospitalization, the SARC-F questionnaire was used to detect sarcopenia syndrome, patients who scored more than 4 points were included in the main stage of the study to detect sarcopenia according to the EWGSOP 2. Statistical processing was carried out using the SPSS Statistics 23 software package. 
Results. During the study period, 232 patients were examined, of which 147 (63% of the total number of patients, 35 men (24%), 112 women (76%), average age — 70 ± 8 years), presarcopenia was detected in 87 people (59% of the total number of patients). When comparing the control group (60 people, 41% of the number included in the study) and patients with presarcopenia, statistically significant differences in uric acid levels (p = 0.001), C-reactive protein (p = 0.001), ESR (p = 0.0001), and albumin (p = 0.001) were noted. Higher values of uric acid (OR 1.028; 95% CI 1.003–1.053), ESR (OR 1.366; 95% CI 1.051–1.776), C-reactive protein (OR 1.93; 95% CI 1.185– 3.145), and decreased serum albumin (OR 2.182; 95% CI 1.064–4.475) were independent risk factors for the development of presarcopenia in men and women with type 2 diabetes. The area under the ROC curve corresponding to the relationship of the combined risk factors: uric acid levels, C-reactive protein, albumin, ESR, and the probability of outcome P was 0.907 ± 0.025 with 95% CI 0.858–0.956. 
Conclusions. The study demonstrates that patients with diabetes mellitus have a high prevalence of the initial stage of sarcopenia, presaccumulation, when the body’s muscle reserves are not exhausted. Elevated values of ESR, C-reactive protein, uric acid levels, as well as lower albumin levels may be risk factors for sarcopenia. This circumstance should be taken into account in the management of patients with impaired carbohydrate metabolism in the older age group and timely correction should be carried out.

In this study, the relationship between the results of positron emission tomography (PET) with fluorodeoxyglucose (FDG) in patients with lymphomas and their progression-free survival (PFS) was analyzed. The aim of the study was to determine whether there are differences in the level of FDH absorption and tumor volume in patients with different periods of PFS after treatment and a score of 3 points on the PET scale. The average values of FDG uptake and tumor volume in patients with different periods of AFD were calculated and compared. It was revealed that in patients with a period of PFS of more than 24 months, there are statistically significant differences in both parameters. These results can be used as an additional factor in predicting the disease in patients with lymphomas after treatment and a 3-point PET score.

Objective: to study the isolated effect of the superior mesenteric artery on pathological processes in the LRV basin from the standpoint of anatomical variants of syntopy and hydrodynamic impact. 
Material and methods. The study was conducted on 100 cadavers. The hemodynamic impact was studied by examining the syntopy of the superior mesenteric artery using mathematical techniques and hemodynamics. 
Results and discussion. During the study of cadaveric material, abnormal syntopy of the left renal vein was observed, affecting hemodynamics. During the period of pre-ejection of blood from the left ventricle of the heart, the time of blood ejection from the left ventricle is about 0.24 sec. In this case, the pulse pressure in the aorta begins to increase at the moment of the beginning of blood ejection from the left ventricle. This pressure impulse causes movement of the arterial wall, and, accordingly, the vein wall by the maximum amplitude of 4.65 mm. The blood velocity under the action of this pressure impulse is approximately 0.0465 m/sec. Since the pulsation pressure is transmitted in the venous blood flow in all directions without change, this pressure coincides with the direction of flow in the vein behind the point of contact of the vein with the artery, and is directed towards the blood flow in front of the point of contact. Therefore, the anterior part of the pressure pulse increases the blood flow velocity behind the point of contact of the vein with the aorta by the value of V/2 (23.25 mm/sec) in the layer adjacent to the surface of the vein, and the posterior part of the pulse slows down the blood flow in front of the point of contact by the same value. Such distribution of pressures and blood flow velocities in the vein partially slows down the flow in the vein, and the pressure pulse in the artery, being transmitted to the venous blood flow, partially blocks its lumen. The pressure pulsation in the artery, being transmitted to the venous blood flow, increases the blood flow velocity behind the point of contact of the vein with the aorta by the value of 2.225 cm/sec and, thereby, increases the average velocity of blood movement in the vein. This pulsation results in a local increase in pressure before the contact zone by approximately 1.15 Pa at the peak of the pulsation wave in the fluid layer adjacent to the vein surface with a gradual decrease in pressure with distance from the vessel center. 
Conclusions. A group of causes for the syntopy of the superior mesenteric artery and left renal vein was discovered, causing difficulty in venous outflow and the development of hypertension in the left renal vein basin. The resulting distribution of pressures and blood flow velocities in the vein partially inhibits the flow in the vein at the moment of pressure impulse passage in the artery.

Anemia is a syndrome that often occurs in the elderly and is associated with a poor prognosis. The etiological structure of anemia in the elderly (AE) is diverse. One of the most important pathogenetic mechanisms for the development of anemia of various etiologies is inadequate production of erythropoietin (EPO). 
Objective: to determine the prevalence of anemia of various etiologies and the adequacy of EPO production in response to anemia among elderly patients. 
Material and methods. A group of 210 patients, the average age was 77.54 ± 8.47 years. The exclusion criteria – malignant neoplasm or oncohematological disease. Etiological factors of AE were defined as iron deficiency (IDA), B12, folic acid, inflammation (ACD), chronic kidney disease (CKD) and their combinations. The adequacy of EPO production was assessed by the ratio of the logarithm of the determined EPO value to the logarithm of the expected EPO value (0/P lg EPO) obtained for the reference group of patients and using covariance analysis. 
Results. AE has one cause of development only in 35.2% of cases, in the rest it is a combination of factors. The etiologic structure of AE depending on the leading pathogenetic mechanism: IDA — 9.5%, IDA with CKD — 27%, CKD with GFR less than 60 ml/min/1.73 m2 — 13.8%, CKD with GFR less than 30 ml/min/1.73 m2 —7.6%, B 12 deficiency — 9%, ACD — 14.8%, unexplained anemia of the elderly (UAE) —18%. Inadequate EPO production was observed in the groups of patients with IDA with CKD, CKD, ACD, and UAE; in the groups with IDA and B12-deficient anemia, EPO production was adequate. 
Conclusions.The prevalence of UAE depends on the selection criteria. Approximately 2/3 of AE cases are polyetiologic. Due to the polyetiology of AE, it is difficult to accurately divide elderly patients by the etiologic sign of anemia. The cause of inadequate EPO production in AE is CKD and inflammation. Inadequate EPO production is observed already with a decrease in GFR to less than 60 ml/min/1.73 m2.

The elderly population consumes a disproportionate share of medicines (medicines) compared to younger people. About 30% of persons aged 65 years and older receive 5 or more medications per day. Polypragmasia in the elderly can lead to multiple drug interactions (DIs), use of potentially not recommended therapy (PNT), and resulting adverse drug reactions (ADRs). Given the increase in endocrine diseases, particularly diabetes mellitus, among the elderly, it is imperative that health care providers are aware of the potential benefits and risks associated with multidrug therapy. 
Aim. To assess the incidence of polypragmasia, potentially irrational therapy according to Beers 2023 criteria and significant drug interactions, and to search for risk factors for polypragmasia among elderly people with endocrine diseases at the inpatient stage of medical care. 
Material and methods. An observational one-stage single-center single-sample uncontrolled study was conducted on the basis of Endocrinology Research Centre. Performed a review of medical records of inpatients aged 65 years and older hospitalized between September and December 2019 for polypragmasy, PNT in accordance with the Beers 2023 criteria and potentially significant drugs using the Drug Interactions Checker online calculator. 
Results. The study included 54 patients aged 65 years and older, the median age of the total group was 69 years [67; 72]. The median number of drugs prescribed to patients was 9 [7; 11]. Polypragmasia (prescription of 5 or more drugs) was observed in 90.74% of cases, and excessive polypragmasia (prescription of 10 or more drugs) — in 42.59%. The frequency of PST was 46.3%. The frequency of potentially significant LS was 40.74%. The chance of prescribing 5 or more LS was significantly higher in individuals with coronary heart disease (CHD). 
Conclusion. Elderly inpatients with endocrine diseases are at high risk of polypragmancy and PST. There is a clear need to audit drug prescriptions in this highly vulnerable patient group using pharmacotherapy optimization tools such as the Beers 2023 criteria and the Drug Interactions Checker online calculator. Elderly endocrine patients with CHD require special attention and monitoring by health care providers due to the high risk of polypragmancy and, as a consequence, the use of PNT and the development of ADRs.

Pulmonary sequestration is a rare congenital anomaly of lung tissue development. This condition involves the isolation of a lung fragment from the bronchial tree, with its blood supply provided by an aberrant artery, most commonly arising from the descending aorta. Surgical intervention remains the standard treatment method; however, international studies indicate a high risk of perioperative complications, underscoring the importance of thorough evaluation of surgical indications and careful postoperative monitoring. This article presents a clinical case of a 28-year-old female patient diagnosed with “Left lung sequestration”. The case highlights the significance of comprehensive diagnostic evaluation in patients with hemoptysis and recurrent pneumonia in the same lung region, even at a young age. Early detection and timely treatment of such pathology contribute to improved prognosis and reduced risk of complications.

Gout is a systemic disease characterized by the deposition of sodium monourate crystals in various tissues with the development of chronic inflammation and hyperuricemia. A rare case of the development of gouty tophi in the myocardium complicated by a purulent-necrotic process in a patient with gout is presented. Case description. The corpse of L.P., 30 years old, was found at home; the patient did not seek medical help. Several gouty tophi were detected in the heart. Histological examination revealed a large array of amorphous inhomogeneous mass in the thickness of the myocardium, which was framed by a fibrosis zone. Muscle fibers were relaxed, wave-like deformed, with moderately loosened swollen myoplasm, dull nuclei. Monourate Na crystals with a perifocal giant cell inflammatory reaction were determined in all the described tophi. Diagnosis: Gout: gouty tophi in the thickness of the myocardium of the interventricular septum, wall of the left ventricle. Generalized embolization of the vessels of the microcirculatory bed with a basophilic substrate. Phlegmonous inflammation of the myocardium. 
Conclusion. In the presented case, gouty tophi were detected in the heart with the development of purulent-necrotic decay and the development of exudative inflammation with generalized embolization of the vessels of the microcirculatory bed with a basophilic substrate. This case is rare and has practical interest, since it developed at a young age with local damage to the heart.

The article presents a clinical case of a diagnostically difficult disease – arrhythmogenic cardiomyopathy in a patient with paroxysmal atrial fibrillation. The complexity of this diagnosis is due to the fact that it can only be made retrospectively, when after successful rhythm control, including cardioversion or ablation, the systolic function of the left ventricle is restored and clinical symptoms disappear. The issues of the prevalence of the disease and its place in the modern classification of cardiomyopathies are considered. The features of structural, functional and hemodynamic changes in the heart are noted. Modern approaches to the diagnosis of the disease and the choice of an effective treatment strategy are discussed.

The article presents historical information and biographical data of military doctors and nurses during the First Wave of emigration and their lives and activities in Europe (Germany, Czechoslovak Republic, Belgium).

The key milestones in the life and work of Academician of the USSR Academy of Medical Sciences A.N. Bakuleva. Some littleknown facts from the life of a scientist are covered. The career successes and main scientific achievements of A.N. Bakuleva. It is shown that in all the successes of modern heart and vascular surgery in our country, a significant share of the work of A.N. Bakulev, who, together with other surgeons, primarily P.A. Kupriyanov, B.V. Petrovsky, A.A. Vishnevsky, N.M. Amosov, created the basis for the widespread development of this new branch of medicine. A.N. Bakulev created a large school of surgeons working in the field of pulmonary and cardiovascular surgery. A distinctive trait that he undoubtedly adopted and developed from his mentor was the ability to find students, believe in them and nurture them. He was strict and demanding when it came to a patient or omissions in scientific work, especially the reliability of the statistical data obtained, but he always tried to help everyone. A.N. Bakulev was not afraid to promote young people and taught them. This is what ensured that both in the clinic, which he led for about 24 years, and in the Institute of Cardiovascular Surgery, which he headed, the education of worthy replacements. Students of A.N. Bakulev worked in many cities of our country and adequately developed Soviet medicine.